Saving lives and resources by preventing osteoporotic fractures with dairy products
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1 Saving lives and resources by preventing osteoporotic fractures with dairy products CERIN-EMF-GDP LUNCH SYMPOSIUM Dr Mickael Hiligsmann, PhD Assistant Professor in Health Economics and Health Technology Assessment WCO-IOF-ESCEO Florence, 25 March 2017 WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 1
2 Background - implementation of a nutrition program? Clinical evidence Societal impact Economic impact WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 2
3 Criteria used to assess health products Health Technology Assessment, European Parliament, 2015 WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 3
4 Aim of this presentation Public health impact Saving lives? Dairy products Economic impact Saving resources? WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 4
5 Measuring public health impact Clinical outcome: number of (hip) fractures prevented Life years: number of years saved Quality adjusted life years: number of QALY gained QALY = years X utility 0 1 Death Perfect health 1 QALY = 1 year in perfect health WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 5
6 Example 15,900,000 aged over 60 years Hip Fractures 51,662 (Women) 15,482 (men) Low dietary intake of calcium and vitamin D Ref: Briot et al. Bone (2015) ; INSEE WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 6
7 Recommended intake of dairy products Lifetime impact Fractures prevented Life years gained QALY gained 1 year (2015) +60y Hiligsmann et al. Osteoporos Int. 2017;28(3): WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 7
8 Methods Markov microsimulation model Fracture incidence, mortality, fracture cost, fracture disutility Dairy products Effects on fracture from Cochrane review 16% (Hip), 14% (Vertebral) 11% (other) Avenell et al 2014 Cochrane Database Syst Rev 4:CD WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 8
9 Health impacts of the recommended intake of dairy products in the general French population over 60 years for 1 year Hip fractures First year: 8,000 women 2,500 men 126 millions saved (hospitalization) Subsequent years: 7,000 women 1,900 men Lifetime Women Men 4413 Hip fractures All fractures Hiligsmann et al. Osteoporos Int. 2017;28(3): WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 9
10 Health impacts of the recommended intake of dairy products in the general French population over 60 years for 1 year Women Men Fractures prevented QALY gained Life years gained Hiligsmann et al. Osteoporos Int. 2017;28(3): WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 10
11 Number of FX prevented Increasing life expectancy increase in projected health impacts : +33% Women Women Women 80+ Men Men Men : +77% WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 11
12 Public health impact Saving lives? Dairy products Economic impact Saving resources? WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 12
13 Measuring economic impact Societal perspective Quality-adjusted lifeyears Cost A Cost B Intervention A Intervention B Outcome A Outcome B Differences in costs? Differences in outcomes? Relationship? WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 13
14 COSTS OUTCOME fracture costs dairy costs ( 0.54/day for 2 products) More COSTS More QALYs WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 14
15 Measuring economic impact Incremental cost-effectiveness ratio ICER = (C A C B ) / (E A E B ) = C/ E = The additional cost per extra unit of effect from the comparator treatment Intervention adopted if ICER < λ (= willingness to pay per effectiveness unit) ICER < 2 X GDP (68,000 ) ICER < 30,000 ) ICER > 2 X GDP (68,000 ) WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 15
16 Cost per QALY gained +60y Overall Overall Women One dairy product per day Hiligsmann et al. Osteoporos Int. 2017;28(3): WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 16
17 Cost-effectiveness dairy products General population aged over 60 years Border of efficiency Highly cost-effective (ICER <30,000) Women aged over 70 years Men aged over 80 years Hiligsmann et al. Osteoporos Int. 2017;28(3): WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 17
18 Cost per QALY gained High-risk population Women with low BMD Women with PVF y 70 y 80 y Ethgen et al. Osteoporos Int (2016) 27: WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 18
19 Vitamin D and calcium food-fortification programme in the German female population aged 65 years and older Annual net cost savings of 315 million Annual total number of fractures prevented: 36,705 Sandman et al. Public Health Nutr Nov 16:1-10 WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 19
20 Public health impact Saving lives? Dairy products Economic impact Saving resources? Value for money WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 20
21 Discussion Effectiveness of dairy products (real-life studies) Willingness to consume fortified dairy products large majority of Germans would be willing to consume vitamin D-fortified dairy products (1) higher willingness to consume for nutritional products Adherence to dairy products Increase in expected benefits in population aged over 80 years Other effects of calcium and vitamin D (1) Sandman et al. Food Qual Prefer Jul;43:53-62 WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 21
22 Dairy products Substantial public health impact saving lives Efficient allocation of resources saving resources => Need for dairy products programmes/support WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 22
23 Thank you for your attention Mickael Hiligsmann, PhD Assistant Professor in Health Economics & HTA Maastricht University WCO-ESCEO-IOF Florence 2017 CERIN-EMF-GDP Lunch Symposia 23
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An Economic Evaluation of Salt Reduction as a Population Based Intervention for the Prevention of Coronary Heart Disease in Four Eastern Mediterranean Countries (Palestine, Syria, Tunisia, Turkey) Cost
Ghada El-Hajj Fuleihan, MD,MPH.
Ghada El-Hajj Fuleihan, MD,MPH. Dr El-Hajj Fuleihan is Professor of Medicine and Founder and Director of the Calcium Metabolism and Osteoporosis Program at the American University of Beirut Medical Center.
Make your. first break. your last.
www.iofbonehealth.org Make your first break your last WHAT IS OSTEOPOROSIS? Osteoporosis is a disease in which bones become more fragile and weak, leading to an increased risk of fractures (broken bones).
Purpose. Methods and Materials
Prevalence of pitfalls in previous dual energy X-ray absorptiometry (DXA) scans according to technical manuals and International Society for Clinical Densitometry. Poster No.: P-0046 Congress: ESSR 2014